National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Adverse Drug Events (ADE) (1)
- Adverse Events (4)
- Communication (1)
- Comparative Effectiveness (2)
- Diabetes (1)
- Disabilities (3)
- Healthcare Cost and Utilization Project (HCUP) (1)
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- Health Services Research (HSR) (2)
- Hospital Discharge (1)
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- (-) Labor and Delivery (24)
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- Medical Liability (1)
- Medication (2)
- Mortality (2)
- Neonatal Intensive Care Unit (NICU) (1)
- Newborns/Infants (4)
- Outcomes (3)
- Patient-Centered Outcomes Research (3)
- Patient Safety (4)
- Policy (1)
- Practice Patterns (1)
- Pregnancy (13)
- Public Health (1)
- Quality Improvement (1)
- Racial and Ethnic Minorities (2)
- Risk (3)
- Social Determinants of Health (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 24 of 24 Research Studies DisplayedAttanasio LB, Hardeman RR, Kozhimannil KB
Prenatal attitudes toward vaginal delivery and actual delivery mode: variation by race/ethnicity and socioeconomic status.
This study examined whether women's prenatal attitudes toward vaginal delivery differed by race/ethnicity or socioeconomic status, and whether attitudes were differently related to delivery mode depending on race/ethnicity or socioeconomic status. The study concluded that there are racial/ethnic differences in chances of cesarean delivery, and these differences are not explained by birth attitudes. Findings also suggested that white and high-socioeconomic status women may be more able to realize their preferences in childbirth.
AHRQ-funded; HS024215.
Citation: Attanasio LB, Hardeman RR, Kozhimannil KB .
Prenatal attitudes toward vaginal delivery and actual delivery mode: variation by race/ethnicity and socioeconomic status.
Birth 2017 Dec;44(4):306-14. doi: 10.1111/birt.12305..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Racial and Ethnic Minorities, Social Determinants of Health
Markowitz S, Adams EK, Lewitt MJ
Competitive effects of scope of practice restrictions: public health or public harm?
This paper examined the case of scope of practice (SOP) restrictions for certified nurse midwives and evaluated the effects of changes in states' SOP laws on markets for CNMs and on maternal and infant outcomes. The authors found that SOP laws are neither helpful nor harmful in regards to health outcomes but states that have no SOP-based barriers have lower rates of induced labor and Cesarean section births.
AHRQ-funded; HS024530.
Citation: Markowitz S, Adams EK, Lewitt MJ .
Competitive effects of scope of practice restrictions: public health or public harm?
J Health Econ 2017 Sep;55:201-18. doi: 10.1016/j.jhealeco.2017.07.004..
Keywords: Health Services Research (HSR), Labor and Delivery, Pregnancy, Public Health, Policy
Lapcharoensap W, Lee HC
Tackling quality improvement in the delivery room.
Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally. This article discusses how the delivery room is a unique environment and presents examples on how to approach delivery room quality improvement (QI). Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Lee HC .
Tackling quality improvement in the delivery room.
Clin Perinatol 2017 Sep;44(3):663-81. doi: 10.1016/j.clp.2017.05.003.
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Keywords: Communication, Labor and Delivery, Newborns/Infants, Quality Improvement, Patient Safety
Metz TD, Gonzalez C, Allshouse AA
Influence of patient-level factors on mode of delivery among operative vaginal delivery candidates in modern practice.
This study aimed to evaluate which patient-level factors influence mode of delivery among candidates for operative vaginal delivery. Odds of forceps versus vacuum were higher with induction, nulliparity, epidural, maternal indication, older maternal age, and longer second stage. Odds of cesarean versus operative vaginal delivery were higher with maternal indication, a perinatologist, longer second stage, older gestational age and longer labor.
AHRQ-funded; HS022143.
Citation: Metz TD, Gonzalez C, Allshouse AA .
Influence of patient-level factors on mode of delivery among operative vaginal delivery candidates in modern practice.
Am J Perinatol 2017 Aug;34(10):974-81. doi: 10.1055/s-0037-1601441.
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Keywords: Adverse Events, Healthcare Delivery, Labor and Delivery, Pregnancy, Women
Jensen EA, Lorch SA
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
This study assessed the independent association between overnight or "off-peak" hour delivery and 3 neonatal morbidities strongly associated with childhood neurocognitive impairment. It found that very low birth weight infants born between midnight and 7:00 a.m. are at increased risk for severe intraventricular hemorrhage and death or major neonatal morbidity.
AHRQ-funded; HS015696.
Citation: Jensen EA, Lorch SA .
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
J Pediatr 2017 Jul;186:41-48.e4. doi: 10.1016/j.jpeds.2017.02.007.
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Keywords: Labor and Delivery, Mortality, Newborns/Infants, Adverse Events
Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG
Live birth, miscarriage, and abortion among U.S. women with and without disabilities.
Researchers compared proportions of live birth, miscarriage, and abortion among women with basic action difficulties, women with complex activity limitations, and women without disabilities in a nationally representative sample. They found few differences between women with and without disabilities, and good likelihood of live birth among women with disabilities experiencing pregnancy.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Kulkarni-Rajasekhara S, Darney BG .
Live birth, miscarriage, and abortion among U.S. women with and without disabilities.
Disabil Health J 2017 Jul;10(3):382-86. doi: 10.1016/j.dhjo.2017.02.006.
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Keywords: Disabilities, Labor and Delivery, Medical Expenditure Panel Survey (MEPS), Pregnancy
Masinter LM, Dina B, Kjerulff K
Short interpregnancy intervals: results from the first baby study.
Short interpregnancy interval (SIPI), defined as 18 months or fewer between delivery and subsequent conception, has become an independent marker of maternal and child health. The authors of this study performed a secondary analysis of 18 months of data from The First Baby Study, a prospective cohort of women followed from pregnancy through 3 years after their first birth.
AHRQ-funded; HS000078.
Citation: Masinter LM, Dina B, Kjerulff K .
Short interpregnancy intervals: results from the first baby study.
Womens Health Issues 2017 Jul - Aug;27(4):426-33. doi: 10.1016/j.whi.2017.02.011..
Keywords: Pregnancy, Labor and Delivery, Women
Horner-Johnson W, Biel FM, Darney BG
Time trends in births and cesarean deliveries among women with disabilities.
This study assessed time trends in births by any mode and in primary cesarean deliveries among women with physical, sensory, or intellectual/developmental disabilities. Among all women giving birth, the proportion with a disability increased from 0.27 percent in 2000 to 0.80 percent in 2010. Women with disabilities had significantly elevated odds of primary cesarean delivery in each year, but the magnitude of the odds ratio decreased over time.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Biel FM, Darney BG .
Time trends in births and cesarean deliveries among women with disabilities.
Disabil Health J 2017 Jul;10(3):376-81. doi: 10.1016/j.dhjo.2017.02.009.
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Keywords: Disabilities, Labor and Delivery, Pregnancy
Attanasio LB, Kozhimannil KB, Srinivas SK
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Researchers compared women's self-reported reasons for cesarean with their hospital discharge records and examined correlates of variability in agreement between sources. Ninety-one percent of women reported a reason for their cesarean that was present in the discharge data. Positive predictive value (PPV), the probability that women's self-reported reasons for cesarean varied by reason for cesarean, with high PPV for dystocia, macrosomia, and cephalopelvic disproportion (91.1 percent), and lower PPV for malposition (81.7 percent).
AHRQ-funded; HS024215.
Citation: Attanasio LB, Kozhimannil KB, Srinivas SK .
Concordance between women's self-reported reasons for cesarean delivery and hospital discharge records.
Womens Health Issues 2017 May - Jun;27(3):329-35. doi: 10.1016/j.whi.2016.12.006.
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Keywords: Hospital Discharge, Labor and Delivery, Pregnancy, Women
Sjaarda LA, Radin RG, Silver RM
AHRQ Author: Mitchell E
Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial.
This study investigated the effect of preconception-initiated low dose aspirin (LDA) on pregnancy rate, pregnancy loss, live birth rate, and inflammation during pregnancy. It concluded that in women attempting conception with elevated high sensitivity C-reactive protein (hsCRP) and prior pregnancy loss, LDA may increase clinical pregnancy and live birth rates to those of women without inflammation and reduce hsCRP elevation during pregnancy.
AHRQ-authored.
Citation: Sjaarda LA, Radin RG, Silver RM .
Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial.
J Clin Endocrinol Metab 2017 May;102(5):1495-504. doi: 10.1210/jc.2016-2917.
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Keywords: Pregnancy, Medication, Outcomes, Labor and Delivery
Darney BG, Biel FM, Quigley BP
Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
This study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery. It found that women across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type.
AHRQ-funded; HS022981.
Citation: Darney BG, Biel FM, Quigley BP .
Primary cesarean delivery patterns among women with physical, sensory, or intellectual disabilities.
Womens Health Issues 2017 May - Jun;27(3):336-44. doi: 10.1016/j.whi.2016.12.007.
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Keywords: Disabilities, Labor and Delivery, Patient-Centered Outcomes Research, Pregnancy, Women
Korst LM, Feldman DS, Bollman DL
Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
The researchers examined the extent to which hospitals could be classified by increasingly sophisticated maternal levels of care. They concluded that childbirth services varied widely across California hospitals, and most hospitals did not fit easily into proposed levels. Cognizance of this existing variation is critical to determining the optimal configuration of services for basic, intermediate, and regional maternal levels of care.
AHRQ-funded; HS020915.
Citation: Korst LM, Feldman DS, Bollman DL .
Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
Am J Obstet Gynecol 2015 Oct;213(4):527.e1-27.e12. doi: 10.1016/j.ajog.2015.07.014..
Keywords: Labor and Delivery, Maternal Care, Hospitals, Access to Care
Feldman DS, Bollman DL, Fridman M
Do laborists improve delivery outcomes for laboring women in California community hospitals?
The researchers sought to determine the impact of the laborists staffing model on cesarean rates and maternal morbidity in California community hospitals. They were unable to demonstrate differences in cesarean and maternal childbirth complication rates in community hospitals with and without laborists.
AHRQ-funded; HS020915.
Citation: Feldman DS, Bollman DL, Fridman M .
Do laborists improve delivery outcomes for laboring women in California community hospitals?
Am J Obstet Gynecol 2015 Oct;213(4):587.e1-87.e13. doi: 10.1016/j.ajog.2015.05.051..
Keywords: Labor and Delivery, Outcomes, Patient Safety, Women
Korst LM, Feldman DS, Bollman DL
Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
The objective of the study was to describe the resources and activities associated with childbirth services. It concluded that childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women.
AHRQ-funded; HS020915.
Citation: Korst LM, Feldman DS, Bollman DL .
Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
Am J Obstet Gynecol 2015 Oct;213(4):523.e1-8. doi: 10.1016/j.ajog.2015.08.013..
Keywords: Labor and Delivery, Maternal Care, Hospitals, Access to Care
Tilden EL, Lee VR, Allen AJ
Cost-effectiveness analysis of latent versus active labor hospital admission for medically low-risk, term women.
The purpose of this study was to assess the outcomes and costs of hospital admission during the latent versus active phase of labor. It found that delaying admission until active labor would result in 672,000 fewer epidurals, 67,232 fewer cesarean deliveries, and 9.6 fewer maternal deaths in our theoretic cohort as compared to admission during latent labor.
AHRQ-funded; HS017582.
Citation: Tilden EL, Lee VR, Allen AJ .
Cost-effectiveness analysis of latent versus active labor hospital admission for medically low-risk, term women.
Birth 2015 Sep;42(3):219-26. doi: 10.1111/birt.12179..
Keywords: Labor and Delivery, Comparative Effectiveness, Healthcare Costs, Patient-Centered Outcomes Research, Hospitalization
Andrews SE, Alston MJ, Allshouse AA
Does the number of forceps deliveries performed in residency predict use in practice?
The researchers aimed to determine whether a threshold number of forceps deliveries in residency predicts use of forceps in independent practice. They concluded that, although exceeding 13 forceps deliveries made it highly likely that obstetricians would use them in practice, further study is necessary to set goals for a number of resident forceps deliveries that translate into use in practice.
AHRQ-funded; HS022143.
Citation: Andrews SE, Alston MJ, Allshouse AA .
Does the number of forceps deliveries performed in residency predict use in practice?
Am J Obstet Gynecol 2015 Jul;213(1):93.e1-4. doi: 10.1016/j.ajog.2015.03.025..
Keywords: Labor and Delivery, Patient-Centered Outcomes Research, Practice Patterns, Training, Women
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL
Maternal age and risk of labor and delivery complications.
The researchers examined associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. Using HCUP data, they found that complications with the highest odds among women 11-18 years of age included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women 35 and older had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Women over 40 had increased odds for mild preeclampsia, fetal distress, and poor fetal growth.
AHRQ-funded; HS019455.
Citation: Cavazos-Rehg PA, Krauss MJ, Spitznagel EL .
Maternal age and risk of labor and delivery complications.
Matern Child Health J 2015 Jun;19(6):1202-11. doi: 10.1007/s10995-014-1624-7.
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Keywords: Adverse Events, Healthcare Cost and Utilization Project (HCUP), Labor and Delivery, Pregnancy, Risk
Camelo Castillo W, Boggess K, Sturmer T
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
The purpose of this study was to estimate the risks of adverse pregnancy outcomes among women receiving glyburide compared with insulin for the treatment of gestational diabetes mellitus (GDM) in a US population-based cohort. It found an association between glyburide (compared with insulin) and elevated risk of NICU admission, neonatal hypoglycemia, respiratory distress, birth injury, and large for gestational age in women with GDM.
AHRQ-funded; HS017950.
Citation: Camelo Castillo W, Boggess K, Sturmer T .
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
JAMA Pediatr 2015 May;169(5):452-8. doi: 10.1001/jamapediatrics.2015.74..
Keywords: Adverse Drug Events (ADE), Adverse Events, Comparative Effectiveness, Diabetes, Labor and Delivery, Maternal Care, Medication, Newborns/Infants, Outcomes, Pregnancy, Women
Huesch M, Doctor JN
Factors associated with increased cesarean risk among African American women: evidence from California, 2010.
The researchers studied the association of maternal health in African American women in hospitals or communities with the rates of cesarean delivery of infants. They found that cesarean rates were significantly higher overall for African American women than other women (unadjusted rate 36.8 percent vs 32.7 percent), as were both elective and emergency primary cesarean rates.
AHRQ-funded; HS021868.
Citation: Huesch M, Doctor JN .
Factors associated with increased cesarean risk among African American women: evidence from California, 2010.
Am J Public Health 2015 May;105(5):956-62. doi: 10.2105/ajph.2014.302381..
Keywords: Labor and Delivery, Maternal Care, Racial and Ethnic Minorities
Metz TD, Allshouse AA, Faucett AM
Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries.
This study evaluated whether an existing vaginal birth after cesarean (VBAC) prediction model validated for women with one prior cesarean delivery also accurately predicts the likelihood of VBAC in women with two prior cesarean deliveries. It found that the estimates of VBAC success based on the Maternal-Fetal Medicines Units prediction model are similar to the actual rates observed among women with two prior cesarean deliveries.
AHRQ-funded; HS022143.
Citation: Metz TD, Allshouse AA, Faucett AM .
Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries.
Obstet Gynecol 2015 Apr;125(4):948-52. doi: 10.1097/aog.0000000000000744..
Keywords: Labor and Delivery, Pregnancy, Women
Marshall NE, Vanderhoeven J, Eden KB
Impact of simulation and team training on postpartum hemorrhage management in non-academic centers.
The researchers conducted a multi-center study to evaluate in situ simulation and team training for postpartum hemorrhage management (PPH) among experienced clinical teams in non-academic hospitals in urban and rural communities. They found that team training significantly improved response times in the management of PPH, including the recognition of PPH, time to administer first medication, performance of uterine massage and time to administer second medication.
AHRQ-funded; HS015800; HS016673.
Citation: Marshall NE, Vanderhoeven J, Eden KB .
Impact of simulation and team training on postpartum hemorrhage management in non-academic centers.
J Matern Fetal Neonatal Med 2015 Mar;28(5):495-9. doi: 10.3109/14767058.2014.923393..
Keywords: Training, Patient Safety, Labor and Delivery, Women
Santos P, Ritter GA, Hefele JL
Decreasing intrapartum malpractice: targeting the most injurious neonatal adverse events.
The researchers conducted a case study of a risk reduction labor and delivery model at 5 demonstration sites. After 27 months post implementation, reporting of unintended events increased significantly (43 vs 84 per 1000 births), while high-risk malpractice events decreased significantly (14 vs 7 per 1000 births).
AHRQ-funded; HS019608.
Citation: Santos P, Ritter GA, Hefele JL .
Decreasing intrapartum malpractice: targeting the most injurious neonatal adverse events.
J Healthc Risk Manag 2015;34(4):20-7. doi: 10.1002/jhrm.21168..
Keywords: Labor and Delivery, Patient Safety, Risk, Medical Liability, Medical Errors
Witt WP, Wisk LE, Cheng ER
Determinants of cesarean delivery in the US: a lifecourse approach.
The researchers sought to determine whether the effects of preconception stressful life events (PSLEs) on birth weight differed by neighborhood disadvantage. They found that the risk of having very low birthweight infants among women with PSLEs, women with chronic conditions, or minority women was strongest among those living in disadvantaged neighborhoods, which suggests exacerbation of risk within disadvantaged environments.
AHRQ-funded; HS000083; HS000063.
Citation: Witt WP, Wisk LE, Cheng ER .
Determinants of cesarean delivery in the US: a lifecourse approach.
Matern Child Health J 2015 Jan;19(1):84-93. doi: 10.1007/s10995-014-1498-8..
Keywords: Labor and Delivery, Maternal Care, Pregnancy, Risk, Social Determinants of Health
Kastenberg ZJ, Lee HC, Profit J
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.
The study’s aims were to describe the current trend toward deregionalization and to test the hypothesis that infants with necrotizing enterocolitis represent a particularly high-risk subgroup of the VLBW population that would benefit from early identification, increased intensity of early management, and possible targeted triage to tertiary hospitals. It found that outcomes for VLBW infants continue to be suboptimal when they are not born into high-level, high-volume centers.
AHRQ-funded; HS000028.
Citation: Kastenberg ZJ, Lee HC, Profit J .
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.
JAMA Pediatr 2015 Jan;169(1):26-32. doi: 10.1001/jamapediatrics.2014.2085..
Keywords: Newborns/Infants, Labor and Delivery, Mortality, Neonatal Intensive Care Unit (NICU), Healthcare Delivery